POS0363 SEX DIFFERENCES IN CARDIOVASCULAR AND DISEASE-RELATED FEATURES IN AXIAL SPONDYLOARTHRITIS. A MULTICENTERSTUDYOF 912 PATIENTS
Authors: I. Gonzalez-Mazon, I. Ferraz-Amaro, F. Genre Romero, R. Blanco, A. Corrales, V. Portilla, E. Aurrecoechea, M. C. Mata Arnaiz, V. Hernández Hernández, J. C. Quevedo-Abeledo, C. Rodríguez-Lozano, C. López-Medina, M. L. Ladehesa Pineda, S. Castañeda, E. F. Vicente-Rabaneda, C. Fernández-Carballido, M. P. Martínez-Vidal, D. Castro-Corredor, J. Anino-Fernández, D. Peiteado, M. L. García Vivar, E. Galíndez-Agirregoikoa, N. Vegas-Revenga, I. Urionaguena, E. Montes Pérez, C. Fernández-Díaz, M. A. González-Gay, J. Rueda-Gotor
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> There is increasing evidence revealing sex differences in the manifestations of axial spondyloarthritis (axSpA). However, the results in this regard are heterogeneous and studies that analyze the influence of sex on cardiovascular (CV) risk are lacking. <h3>Objectives</h3> To assess the CV profile of male and female axSpA patients and to determine the potential impact of sex-specific disease-related characteristics on atherosclerosis in these patients. <h3>Methods</h3> This is a cross-sectional study of the AtheSpAin cohort, a Spanish multicenter cohort to study atherosclerosis in axSpA. Data on clinical and subclinical atherosclerosis, as well as CV and disease-related characteristics were collected in 912 patients. <h3>Results</h3> 611 men and 301 women were recruited for this study. Smoking habit (p=0.033), hypertension (p=0.009), and dyslipidemia (p=0.015) were less prevalent in women, who also showed less severe atherosclerosis measured by the presence of carotid plaques (p=0.001), carotid intima-media thickness (IMT) values (p&lt;0.001), and CV events (p=0.008). After adjustment for traditional CV risk factors only the results regarding carotid IMT remained statistically significant. Regarding disease-related features, radiographic axSpA (r-axSpA) was more common in men (p&lt;0.001). Women with axSpA showed a shorter disease duration (p&lt;0.001), a lower prevalence of psoriasis (p=0.008), higher ESR levels at diagnosis (p=0.038) and more active disease measured by ASDAS (p=0.012) and BASDAI (p&lt;0.001). However, they had less structural damage (mSASSS, p&lt;0.001) and mobility limitation (BASMI, p=0.033). These differences that remained statistically significant after adjustment for r-axSpA/nr-axSpA, disease duration or smoking. Remarkably, many of these sex-related differentiating characteristics were associated with subclinical atherosclerosis (table 1). To clarify if this finding could lead to sex differences in the atherosclerotic burden, we compared the prevalence of carotid plaques in men and women with the same level of CV risk stratified according to the SCORE. Within the category of low-moderate SCORE, men showed more severe atherosclerosis than women (p=0.050), which could be related to a longer disease duration (p=0.004), higher mSASSS (p=0.001) and BASMI (p=0.071) values. However, in patients with high-very high SCORE, carotid plaques were more commonly observed in the female group (p=0.025), which was characterized by a higher inflammatory burden (ESR at diagnosis, p=0.007) and worse BASFI (p=0.011) compared with men, with no differences regarding disease duration, mSASSS or BASMI. <h3>Conclusion</h3> Although the burden of traditional CV risk factors leading to more severe atherosclerotic disease is greater in men with axSpA, potential sex-related proatherogenic features of axSpA also appear to have an impact on CV risk. This may be especially applicable to women at high CV risk, who have a greater inflammatory response, worse functional impairment, and more severe subclinical atherosclerosis than males, suggesting a closer interaction between atherosclerosis and disease burden in women with axSpA. <h3>Reference</h3> [1]Stovall R, et al. Sexual dimorphism in the prevalence, manifestation and outcomes of axial spondyloarthritis. Nat Rev Rheumatol. 2022 Nov;18(11):657-669 <h3>Acknowledgements</h3> FG and JR-G are beneficiaries of a grant funded by 'Instituto de Salud Carlos III' (ISCIII) (PI20/00059) <h3>Disclosure of Interests</h3> None Declared.